Abdominal pain in children, real or fake?

March 12, 2013

Dr. Jose Derdoy, pediatic gastroenterologist

ST. LOUIS Kids learn early on that if their tummy hurts they may get to stay home with mom or dad. So when a child has recurrent stomach aches, it can be difficult for parents to know how serious it is. As with most issues, there are guidelines to calm parental concerns.

Chronic abdominal pain in childhood and adolescence is a common condition. It’s part of a broader group of functional GI disorders. The term recurrent abdominal pain (RAP) describes the syndrome in childhood as three episodes of abdominal pain within three months severe enough to affect daily activities. While it can be worrisome to all involved, this is a benign condition affecting 10-15 percent of elementary school children and 20 percent of middle and high school students. These students experience abdominal pain on a daily to weekly basis yet only half seek medical attention.

The diagnosis of RAP or CRAP (chronic recurrent abdominal pain) is a clinical one. The good news is that RAP is a functional GI disorder, not a disease. Children with symptoms tend to be anxious, often perfectionists or overachievers.

Absence from school is relatively common among children with RAP. These kids are “frequent flyers,” very well known by the school nurse, local emergency staff and doctors on call. there’s a sharp rise in the incidence of symptoms after age 8 and it’s more common in girls

Psychosocial factors play a significant role. Stressful events such as death or illness in a family member, separation or divorce, and school problems are known to affect GI functions and may exacerbate symptoms. Physical stresses or triggers, such as recent viral infections, dietary factors (lactose intolerance, poor diet and food allergies), stool retention and lack of exercise, may also play a role.

 While not all children can be easily classified into one group, RAP has four subtypes:

  • Functional dyspepsia –discomfort in the upper abdomen with ulcer-type symptoms.
  • Irritable bowel syndrome – previously called “spastic colon” associated with constipation or bloating and relieved by defecation.
  • Functional abdominal pain or “nervous stomach” – continuous or intermittent pain near the belly button.
  • Abdominal migraine – sudden episodes of intense abdominal pain associated with migraine headache, photophobia and cyclical vomiting.

To confirm a diagnosis of RAP, doctors generally spend time with a patient and his/her family to get a medical and family history, do a physical exam and some lab tests. In the process, we exclude red flags suggestive of other issues in these often nervous and anxious kids.

Management of RAP includes lifestyle and dietary changes such as eating more fruits, veggies and avoiding fatty foods along with spicy or fried meals. Some patients need to eat more frequently while for others, sleeping well at night may help. Additional treatments include relaxation therapy, breathing techniques, yoga, coping skills training (distraction techniques for younger patients), etc.  We may also use medications in older patients or teenagers who are frequently missing school and don’t respond to symptomatic therapy like antacids for indigestion and stool softeners for constipation.

The good news, RAP isn’t a disease but a benign functional disorder. The bad news, it’s a chronic and recurrent condition and medications don’t always do the trick. Patients and parents need work together with their doctor on a personalized plan to battle and manage its frustrating symptoms.

Dr. Jose Derdoy is a pediatric gastroenterologist with Mercy Clinic Kids GI and Mercy Children’s Hospital. For more information, please visit www.mercychildrens.net.


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